Tooth Root Fractures: Treatment Options and Concerns

Root fracture

Hello Doctor: My second to last lower tooth underwent root canal treatment and was crowned 10 years ago.
In May of this year, a small abscess the size of a green bean appeared on the inner gum, and I felt a tight pressure in the gum when biting down.
After undergoing laser treatment at Clinic A, the abscess still persisted.
Dr.
A stated that the laser treatment was ineffective and that extraction was the only definitive solution.
Later, after researching online, I tried using a mouthwash called "Sokujin," and it seemed to improve the situation; the abscess shrank, and after drainage, it even disappeared.
However, it reappeared occasionally after late nights.
I returned to Clinic A hoping for another laser treatment, but Dr.
A only examined my mouth and again recommended extraction.
Today, on July 18, I sought treatment at a traditional dental clinic recommended by a friend.
Dr.
B, after removing my crown and taking X-rays, determined that a fractured root was causing bacterial infection, which resulted in a dark shadow at the apex.
However, he mentioned that the fracture was near the cheek side of the root, while the abscess was located on the tongue side of the gum, which he did not explain.
Dr.
B also suggested extraction followed by a bridge.
After discussing my desire to preserve the tooth as much as possible, Dr.
B acknowledged the difficulty and uncertainty of success but expressed willingness to attempt it, for which I am very grateful.
Treatment is scheduled to begin on August 1.
However, after researching today, I found a blind spot: Dr.
B mentioned that success is not guaranteed, but that does not mean recurrence is unlikely.
Additionally, Clinic B is a traditional clinic without advanced technology like lasers, which raises my concerns about sterilization.
Furthermore, a second root canal treatment may weaken the root, increasing the likelihood of another fracture.
My question is, is extraction truly the only option for my condition? If I only undergo a redo of the root canal treatment or apicoectomy, is the recurrence rate high? Clinic A, with advanced technology, is unwilling to treat me and only recommends extraction followed by implantation, while Clinic B is willing to treat me but has concerning sterilization equipment.
Most of the conclusions I found online suggest extraction.
What should I do, Doctor?

Xiao Ying, 30~39 year old female. Ask Date: 2015/07/19

Dr. Zeng Guanghui reply Dentistry

If a dental crown is placed after root canal treatment and, after 10 years, a gum abscess appears, laser treatment may be ineffective.
However, after using mouthwash and drainage, the abscess may shrink or even disappear.
X-rays indicate that the abscess is caused by a fracture in the tooth root leading to bacterial infection.
The treatment depends on the type of fracture; if the fracture extends from the infection to the root, redoing the root canal treatment will not be effective, and extraction may be the only option.
It is recommended to consult a dentist for further evaluation and treatment.

Reply Date: 2015/07/19

More Info

Tooth root fractures and the subsequent complications can be a significant concern for many patients, especially when previous treatments such as root canal therapy have been performed. Your situation, involving a history of root canal treatment, the presence of a fistula (the small bump you described), and the potential for a fractured root, presents a complex clinical picture that requires careful consideration.

Firstly, it is essential to understand that a tooth root fracture can lead to various complications, including infection, abscess formation, and ultimately tooth loss if not managed appropriately. In your case, the presence of a fistula indicates that there is likely an ongoing infection, which can be due to a fractured root or a failed root canal treatment. The fact that you have experienced a recurrent abscess suggests that the underlying issue has not been adequately resolved.

Regarding your treatment options, there are generally three main approaches to managing a fractured tooth root:
1. Retreatment of the Root Canal: If the fracture is not extensive and the tooth structure is still viable, a retreatment of the root canal may be attempted. This involves removing the existing filling material, cleaning the canal system again, and sealing it properly. However, as you mentioned, the success rate of retreatment can vary, and there is a risk that the tooth may become more fragile after this procedure, potentially leading to further fractures.

2. Surgical Intervention: Another option is to perform an apicoectomy, which involves surgically removing the tip of the tooth root along with any infected tissue. This procedure can sometimes save the tooth if the fracture is localized and the rest of the tooth structure is intact. However, this option also carries risks, including the possibility of infection recurrence.

3. Extraction and Replacement: If the fracture is severe or if there is significant bone loss or infection, extraction may be the most prudent option. Following extraction, you could consider options for replacement, such as dental implants or bridges. While this may seem like a drastic step, it can often lead to a more stable and functional outcome in the long term.

Your concerns regarding the sterilization and technology available at the traditional dental clinic (B) are valid. Infection control is crucial in any dental procedure, especially in cases involving surgery or retreatment. It is essential to ensure that the clinic adheres to strict sterilization protocols to minimize the risk of postoperative infections.

Given that the first clinic (A) recommended extraction and the second clinic (B) is willing to attempt a more conservative approach, it may be beneficial to weigh the pros and cons of each option. If you are leaning towards preserving your natural tooth, discussing the potential risks and benefits of retreatment or surgical intervention with B's dentist is essential. Make sure to ask about their experience with similar cases and the success rates of the procedures they propose.

Ultimately, the decision should be based on a thorough understanding of your specific situation, the potential outcomes of each treatment option, and your personal preferences regarding tooth preservation versus the risks of further complications. If you feel uncertain, seeking a third opinion from an endodontist (a specialist in root canal treatment) may provide additional insights and help you make a more informed decision.

In conclusion, while extraction may seem like the most straightforward solution, exploring all options with your dental care providers is crucial. Each case is unique, and with the right approach, it may be possible to save your tooth and avoid the need for extraction.

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